JAMA: Public hospital report cards dont improve CV patient care

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Publicly released report cards that rely heavily on the evaluation of hospitals do not significantly improve patient care, according to a study published Nov. 18 in the Journal of American Medical Association.

Jack V. Tu, MD, PhD, of the division of cardiology at the Institute for Clinical Evaluation Sciences in Toronto, Canada, and colleagues conducted a randomized, population-based trial of 86 Ontario facilities that performed acute cardiac care to patients with two common conditions: acute myocardial infarction (AMI) and congestive heart failure (CHF).

“Although there has been considerable debate, few empirical data exist to determine whether publicly released report cards on hospital performance improve the overall quality of care provided,” wrote the authors.

The facilities, chosen at random, received either January 2004 (early) or September 2005 (delayed) feedback of a publicly released performance report card. The facilities' performances were measured by 12 quality of care indicators for AMI patients and six process of care indicators for CHF patients. The indicators were developed by the Canadian Cardiovascular Outcomes Research Team and the Canadian Cardiovascular Society.

To study the correlation between publicly released report cards and hospital improvements, the researchers analyzed clinical information from 15,997 patient charts during April 2004 and March 2005. A cardiology research nurse from each participating facility performed an analysis of 125 AMI and/or CHF patient charts to determine a baseline assessment of performance and mortality.

Each hospital was analyzed based on performance variables including: study group (early vs. delayed feedback group), stratification factors (teaching vs. large vs. small hospitals) and the hospital-specific performance on the given indicator in the baseline data.

Study results showed that facilities in the early feedback group were 26.5 percent more likely to report quality improvement initiatives for AMI care and 11 percent more likely than the delayed group to report CHF initiatives. In addition, results showed that half of the early feedback group reported introducing new or modified standards for AMI and CHF care.

The authors noted that the “study data likely stimulated some important local, hospital-specific changes in delivery of care that may have contributed to the better outcomes observed at the early feedback hospitals” and said that “greater attention to developing common strategies across hospitals for addressing report card results might enhance the system-wide effectiveness of future report cards.”

Findings showed that AMI mortality rates in the early feedback group were lowered by 2.5 percent. Two-fifths of the early feedback group conducted initiatives to improve reperfusion and five hospitals opened up new CHF clinics.

According to the authors, “the process-of-care findings suggest that public release of hospital-specific performance data may not be a particularly effective system-wide intervention for measurably improving processes of care for either AMI or CHF.”

Study results were submitted and approved by research ethics boards at all participating facilities.